Why don't we talk about pregnancy loss?

In 2021...

357 babies were stillborn or died during the first 28 days of life [1]
- 119 early neonatal deaths (0-7 days)
- 238 stillbirths
7% of stillbirths - cause of death was unknown [1]
Irish Traveller, Asian and Black ethnicities overrepresented in perinatal deaths (12.1% v 5%) [1]. Assessment of risk of perinatal loss associated with ethnic group is impeded by the absence of national data on ethnicity for the pregnant population
Ireland is one of a few countries with a National Perinatal Mortality Audit… However, miscarriages are not recorded at a national level
Molar pregnancy: 1 in 600 pregnancies [2]. Registration with the National GTD Registry is not compulsory
865 ectopic pregnancies [3]
Increase in perinatal mortality (nos. of stillbirths and early neonatal deaths) since 2018. This follows decreasing rates in the decade prior to 2012, and a period of levelling off. In 2021, a slight decrease in perinatal mortality was observed [1]
True incidence of early pregnancy losses likely to be considerably higher, as some women will be treated as outpatients, or may not be managed in hospital, while others may not present to healthcare services at all [4]

Less than 30% of people in a national survey were aware of the incidence of first trimester miscarriage [5]
17% aware of the incidence of stillbirth [6]
56% unable to identify any stillbirth risk factors [6]
78% unaware of molar pregnancy prior to their diagnosis [7]

24% of people rated their overall recurrent miscarriage care experience as poor [8]
36% said the recurrent miscarriage care they received was much worse than expected [8]
26% of people who experienced a second trimester miscarriage, a stillbirth or an early neonatal death rated their care as ‘fair to poor’ [9]
Consistent communication needed in services highlighted in the Maternity Bereavement Experience Survey [9]

60% stated healthcare professionals involved in recurrent miscarriage care in different places did not work well together [8]
50% of healthcare professionals correctly identified the Irish definition of stillbirth [10]
65% of healthcare professionals considered informing women regarding health behaviours & stillbirth risks to be part of their role [10]

82% perceived media to have a role in propagating trainee doctors’ fears of litigation and adverse outcomes [11]
€2.4 billion paid to maternity services negligence claims; some of which relate to potentially avoidable perinatal deaths [12]

Healthcare professionals who were involved in an intrapartum death.....
- 82% received no training in dealing with intrapartum death [13]
- 94% had no education on self-care strategies [13]
- Only 11% were offered debriefing [13]

No routine data on first trimester miscarriage, ectopic pregnancy or molar pregnancy
No updated definition of perinatal mortality
No national care bundle for stillbirths
No national strategy for pregnancy loss
No confidential inquiry - hinders understanding and solutions
Very little mention of pregnancy loss in Government or national policy reports or HSE service plans